PharmacoEconomics

, Volume 19, Issue 6, pp 609–621 | Cite as

Developing Guidance for Budget Impact Analysis

Leading Article

Abstract

The role of economic evaluation in the efficient allocation of healthcare resources has been widely debated. Whilst economic evidence is undoubtedly useful to purchasers, it does not address the issue of affordability which is an increasing concern. Healthcare purchasers are concerned not just with maximising efficiency but also with the more simplistic goal of remaining within their annual budgets. These two objectives are not necessarily consistent.

This paper examines the issue of affordability, the relationship between affordability and efficiency and builds the case for why there is a growing need for budget impact models to complement economic evaluation. Guidance currently available for such models is also examined and it is concluded that this guidance is currently insufficient. Some of these insufficiencies are addressed and some thoughts on what constitutes best practice in budget impact modelling are suggested. These suggestions include consideration of transparency, clarity of perspective, reliability of data sources, the relationship between intermediate and final end-points and rates of adoption of new therapies. They also include the impact of intervention by population subgroups or indications, reporting of results, probability of re-deploying resources, the time horizon, exploring uncertainty and sensitivity analysis, and decision-maker access to the model. Due to the nature of budget impact models, the paper does not deliver stringent methodological guidance on modelling. The intention was to provide some suggestions of best practice in addition to some foundations upon which future research can build.

References

  1. 1.
    Mason J, Drummond M. Cost effective league tables and priority setting. In: Drummond M, Maynard A, editors. Purchasing and providing cost effective health care. Edinburgh: Churchill Livingstone, 1993: 109–25Google Scholar
  2. 2.
    Eddy DM. Oregon’s methods: did cost-effectiveness analysis fail? JAMA 1991; 266 (15): 2135–41PubMedCrossRefGoogle Scholar
  3. 3.
    Commonwealth Department of Human Services and Health. Guidelines for the pharmaceutical industry on the preparation of submissions to the pharmaceutical benefits advisory committee. Canberra: Commonwealth Department of Human Services and Health, 1995Google Scholar
  4. 4.
    Ontario Ministry of Health. Ontario guidelines for economic analysis of pharmaceutical products. Ontario: Ministry of Health, 1994Google Scholar
  5. 5.
    NHS Executive. Faster access to modern treatment. How NICE appraisal will work: a discussion paper. Leeds: NHS Executive, 1999Google Scholar
  6. 6.
    Ziekenfondsraad. Dutch guidelines for pharmacoeconomic research. Amsterdam: Ziekenfondsraad, 1999Google Scholar
  7. 7.
    Infarmed. Methodological guidelines for economic evaluation studies of medications. Lisbon, Portugal: Infarmed, 1999Google Scholar
  8. 8.
    Ministry of Social Affairs and Health. Guidelines for the preparation of an account of health economic aspects [unofficial translation]. Helsinki: Ministry of Social Affairs and Health, 1999Google Scholar
  9. 9.
    Norwegian Medicines Control Authority, Department of Economics. Norwegian guidelines for pharmacoeconomic analysis in connection with application for reimbursement. Oslo: Department of Pharmacoeconomics, Norwegian Medicines Control Agency, 1999Google Scholar
  10. 10.
    Drummond MF, Dubois D, Garrattini L, et al. Current trends in the use of pharmacoeconomics and outcomes research in europe. Value Health 1999; 2 (5): 323–32PubMedCrossRefGoogle Scholar
  11. 11.
    Langley PC, Sullivan SD. Pharmacoeconomic evaluations: guidelines for drug purchasers. J Manage Care Pharm 1996; 2: 671–7Google Scholar
  12. 12.
    Standing Medical Advisory Committee. The use of statins. London: Department of Health, 1997Google Scholar
  13. 13.
    Scandinavian Simvastatin Survival Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383–9Google Scholar
  14. 14.
    Freemantle N, Barbour R, Johnson R, et al. The use of statins: a case of misleading priorities? BMJ 1997; 315: 826–8PubMedCrossRefGoogle Scholar
  15. 15.
    Primatesta P, Poulter NR. Lipid concentrations and the use of lipid lowering drugs: evidence from a national cross sectional survey. BMJ 2000; 321: 1322–5PubMedCrossRefGoogle Scholar
  16. 16.
    Monkman D. Treating dyslipidaemia in primary care [editorial]. BMJ 2000; 321: 1299–300PubMedCrossRefGoogle Scholar
  17. 17.
    Pelen F. Reimbursement and pricing of drugs in France: an increasingly complex system. Health Econ Prev Care 2000; 0 (0): 19–22Google Scholar
  18. 18.
    Duthie T, Trueman P, McCann C, et al. Research into the use of health economics in decision-making in the United Kingdom — phase II: is health economics ‘for good or evil’. Health Policy 1999; 46: 143–57PubMedCrossRefGoogle Scholar
  19. 19.
    Drummond MF, Jefferson TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. BMJ 1996; 313: 275–83PubMedCrossRefGoogle Scholar
  20. 20.
    Gold MR, Siegel JE, Russell LB, et al., editors. Cost effectiveness in health and medicines. New York (NY): Oxford University Press, 1996Google Scholar
  21. 21.
    Canadian Co-ordinating Office for Health Technology Assessment (CCOHTA). Guidelines for economic evaluation of pharmaceuticals: Canada. 2nd ed. Ottawa: CCOHTA, 1997Google Scholar
  22. 22.
    National Institute for Clinical Excellence. Appraisal of new and existing technologies: interim guidance for manufacturers and sponsors. London: National Institute for Clinical Excellence, 1999Google Scholar
  23. 23.
    Mather DB, Sullivan SD, Augustein D, et al. Incorporating clinical outcomes and economic consequences into drug formulary decision: a practical Approach. Am J Manage Care 1999; 5 (3): 277–85Google Scholar
  24. 24.
    Langley PC. Guidelines for formulary submissions for pharmaceutical product evaluation. Denver (CO): Blue Cross Blue Shield of Colorado/Blue Cross Blue Shield of Nevada, 1998Google Scholar
  25. 25.
    Titlow K, Randel L, Clancy C, et al. Drug coverage decisions: the role of dollars and values. Health Aff 2000; 19 (2): 240–7CrossRefGoogle Scholar
  26. 26.
    Department of Health. The new NHS: modern and dependable. London: Department of Health, 1997Google Scholar
  27. 27.
    Wilson H, Scott S. PBMA: its role in the future purchasing arrangements for health care services. Health Policy 1995; 33: 157–60PubMedCrossRefGoogle Scholar
  28. 28.
    Gafni A, Birch S. Guidelines for the adoption of new technologies: a prescription for uncontrolled growth in expenditures and how to avoid the problem. CMAJ 1993; 148 (6): 913–7PubMedGoogle Scholar

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  1. 1.Johnson & Johnson Medical UK LtdAscot, BerkshireUK
  2. 2.Centre for Health EconomicsUniversity of YorkYorkUK
  3. 3.MEDTAP International Inc.LondonUK
  4. 4.Innovus Research Inc.TorontoCanada

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